Cited more often as a factor on death certificates.

Hypertension is increasingly contributing to U.S. mortality, a national death-certificate study showed.

Hypertension-related deaths rose a relative 23.1% -- from 255.1 to 314.1 per 100,000 population from 2000 to 2013 -- after adjustment for age, found Hsiang-Ching Kung, PhD, and Jiaquan Xu, MD, both of the CDC's National Center for Health Statistics in Hyattsville, Md.

This steady rise from 11.1% to 16.4% of all deaths at age 45 or older during that period continued the upward trend observed through the 1980s and 1990s.

By contrast, the mortality rate for all other causes combined fell by a similar degree (21.0%), they reported in the March issue of NCHS Data Brief.

However, hypertension appeared to be a secondary factor, contributing to the primary cause of death in most cases.

About one in six deaths determined to be hypertension related based on death certificate analysis actually stated hypertension as the cause of death, "and the rest had hypertension as a contributing cause of death for other underlying causes."

The other underlying causes to which hypertension most commonly was listed as a contributor on the death certificate were heart disease, stroke, cancer, and diabetes, which together accounted for more than half of hypertension-related deaths.

Notably, heart disease was at the top of that list in 2000 but was overtaken in 2013 by all other causes excluding heart disease, stroke, cancer, hypertension as a primary underlying cause, and diabetes.

Stroke, too, declined as an underlying cause to which hypertension contributed (from 14.9% to 9.2%).

The study used multiple national cause-of-death data files from the National Vital Statistics System and looked only at deaths in people ages 45 and older, because younger people accounted for only about 2% of all decedents with hypertension mentioned on the death certificate.

The upward trend was seen across both sexes, for middle age and elderly groups alike (45 to 64 and 85 and over), and Hispanic and non-Hispanic white populations, but declined among the non-Hispanic black population.

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